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AC-012 Declining semen quality among south Indian infertile men: a retrospective study
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IVF centre of patients with polycystic ovaries undergoing IVF using recombinant FSH (Gonal-F®) and the GnRH antagonist (Cetrotide®) in the flexible protocol. Those who had >25 follicles at the time of oocyte maturation had 1 mg subcutaneous leuprolide acetate (Lucrin®) 36 h before oocyte retrieval instead of HCG for oocyte maturation. From the middle of 2007, all embryos were prospectively cryopreserved. Patients were followed up after oocyte retrieval until they had a period, or (if pregnant) till 12 weeks of gestation. Patients with moderate or severe OHSS would be admitted for assessment, intravenous hydration and/or paracentesis. Results: A total of 52 patients in 55 IVF cycles fulfilled the criteria for inclusion into the study. Five patients had suffered from moderate-severe OHSS in a previous IVF cycle. The average number of follicles aspirated was 46.9 (27–90), yielding an average number of 25.4 oocytes (5–46). The average number of embryos obtained was 14 (0–32). There was one patient who had a total failure of fertilization and only four patients who did not have embryos for cryopreservation after embryo transfer. The overall pregnancy rate was 19% (7/37) per cycle (comprising two who had delivered, one ongoing pregnancy, two miscarriages and two ectopic pregnancies). A total of 47 women in 50 cycles had embryos that were cryopreserved. There were no cases of women who needed admission to hospital for OHSS. During the same time period, there were 477 stimulated IVF cycles where HCG was used for oocyte maturation. The pregnancy rate was 23.7%, but more significantly, there were three cases of severe OHSS (0.63%). Conclusions: The poor pregnancy outcome is similar to the experience of others who used this protocol and is currently thought to be related to a luteal phase problem caused by the GnRH agonist. This prompted the change in study protocol in mid-2007 where all embryos were electively cryopreserved. This study adds further evidence that GnRH agonist for oocyte maturation, in an antagonist protocol, is effective in completely preventing moderate-severe OHSS even in a high-risk group of patients. There is an ongoing study looking at the pregnancy outcome in a subsequent thawed embryo cycle for this group of patients.
Materials/Methods: This retrospective analysis includes a total of 7770 subjects who presented to the Division of Reproductive Medicine for semen analysis from 1993–2005. The data regarding ejaculate volume, sperm density, motility, morphology and the incidence of azoospermia were collected and analysed. Basic descriptive statistics (mean ± standard error) were calculated for the study groups. Statistical analysis of the means between different study periods was performed using one-way analysis of variance (ANOVA) for normality distribution. Regression analysis was carried out using SPSS statistical package. Chi-squared test was performed for analysing the azoospermia incidence. A P-value <0.05 was considered statistically significant. Results: The average sperm count observed during 2004–2005 was 26.61 ± 0.71, which was significantly lower than the mean sperm count observed in 1993–94 (38.18 ± 1.46 million/ml). Similar trend was also seen for sperm motility (47.14% motile spermatozoa versus 61.16%) and normal sperm morphology (19.75% versus 40.51%). The decline in sperm count was 30.31% where as sperm motility and morphology was reduced by 22.92% and 51.25% respectively between the time span of 13 years. Interestingly, the incidence of severe oligozoospermia (mean sperm count <10 million/ml) compared between 2002–2005 and 1993–1997 demonstrated a significant inverse relationship (P < 0.001). Conclusion: This study provides the first evidence that the quality of human semen evaluated for infertility is deteriorating in the southern part of India over years, which may be due to various environmental, nutritional, lifestyle or socio-economic causes. More importantly, the increase in the incidence of sperm morphological abnormalities in addition to low sperm count observed in this study indicates qualitative impairment of spermatogenesis and perhaps of the Sertoli cells. The significant time-related decline in semen quality observed in this study has important implications with respect to fertility. Further studies are warranted, using a large cohort of normal subjects with additional information on their occupation, socioeconomic status, lifestyle-related factors, in order to confirm the findings of the current report.
AC-012
AC-013
Declining semen quality among south Indian infertile men: a retrospective study Jayaraman V, Adiga SK, Kalthur G, Upadhya D, Kumar P Kasturba Medical College, India [email protected]
Correlation between basal FSH and oestradiol concentrations and embryo quality in IVF Guyansyah A, Djuwantono T, Permadi W, Majid TH, Anwar R POGI Indonesia, Indonesia [email protected]
Introduction: Male reproductive function has recently attracted increasing attention due to reports on regional difference and time-related decline in semen quality. Although, the baseline semen quality and sperm functional parameters in fertile Indian men have been documented, the first report investigating changes in semen characteristics in Indian men over the period of time demonstrated no significant decline in sperm count from 1990–2000. In view of high population density, heterogeneous nature of the Indian population, climatic differences and dietary habits, it is necessary to know whether similar trend exists within the different parts of the same country. The specific objective of this study was to investigate the semen quality in terms of the sperm concentration, total sperm motility, sperm morphology and incidence of azoospermia among large cohort of infertile individuals at a regional level over a period of 13 years.
Introduction: Basal hormonal examination is a standard procedure in IVF. Factors that keep IVF from being successful are decrease of quality and follicle reserve in the ovary, which can be predicted by measuring basal follicle stimulating hormone (FSH) and oestradiol concentration. The objective of this study was to determine the correlation between basal FSH, oestradiol concentration and quality of oocytes, clinical pregnancy after ovarian stimulation in IVF. Materials/Methods: This was a retrospective cohort study. Data of patients who undertook the IVF programme and met the inclusion and exclusion criteria were taken from medical records at Aster Fertility Clinic Assisted Reproductive Technology Unit, Department of Obstetric and Gynecology Medical Faculty, University of Padjadjaran/ Hasan Sadikin Hospital Bandung, Indonesia from May 2005 to July 2007. All patients underwent down-regulation using
S-22 Reproductive BioMedicine Online, Vol. 16, Suppl. 2, April 2008
IVF centre of patients with polycystic ovaries undergoing IVF using recombinant FSH (Gonal-F®) and the GnRH antagonist (Cetrotide®) in the flexible protocol. Those who had >25 follicles at the time of oocyte maturation had 1 mg subcutaneous leuprolide acetate (Lucrin®) 36 h before oocyte retrieval instead of HCG for oocyte maturation. From the middle of 2007, all embryos were prospectively cryopreserved. Patients were followed up after oocyte retrieval until they had a period, or (if pregnant) till 12 weeks of gestation. Patients with moderate or severe OHSS would be admitted for assessment, intravenous hydration and/or paracentesis. Results: A total of 52 patients in 55 IVF cycles fulfilled the criteria for inclusion into the study. Five patients had suffered from moderate-severe OHSS in a previous IVF cycle. The average number of follicles aspirated was 46.9 (27–90), yielding an average number of 25.4 oocytes (5–46). The average number of embryos obtained was 14 (0–32). There was one patient who had a total failure of fertilization and only four patients who did not have embryos for cryopreservation after embryo transfer. The overall pregnancy rate was 19% (7/37) per cycle (comprising two who had delivered, one ongoing pregnancy, two miscarriages and two ectopic pregnancies). A total of 47 women in 50 cycles had embryos that were cryopreserved. There were no cases of women who needed admission to hospital for OHSS. During the same time period, there were 477 stimulated IVF cycles where HCG was used for oocyte maturation. The pregnancy rate was 23.7%, but more significantly, there were three cases of severe OHSS (0.63%). Conclusions: The poor pregnancy outcome is similar to the experience of others who used this protocol and is currently thought to be related to a luteal phase problem caused by the GnRH agonist. This prompted the change in study protocol in mid-2007 where all embryos were electively cryopreserved. This study adds further evidence that GnRH agonist for oocyte maturation, in an antagonist protocol, is effective in completely preventing moderate-severe OHSS even in a high-risk group of patients. There is an ongoing study looking at the pregnancy outcome in a subsequent thawed embryo cycle for this group of patients.
Materials/Methods: This retrospective analysis includes a total of 7770 subjects who presented to the Division of Reproductive Medicine for semen analysis from 1993–2005. The data regarding ejaculate volume, sperm density, motility, morphology and the incidence of azoospermia were collected and analysed. Basic descriptive statistics (mean ± standard error) were calculated for the study groups. Statistical analysis of the means between different study periods was performed using one-way analysis of variance (ANOVA) for normality distribution. Regression analysis was carried out using SPSS statistical package. Chi-squared test was performed for analysing the azoospermia incidence. A P-value <0.05 was considered statistically significant. Results: The average sperm count observed during 2004–2005 was 26.61 ± 0.71, which was significantly lower than the mean sperm count observed in 1993–94 (38.18 ± 1.46 million/ml). Similar trend was also seen for sperm motility (47.14% motile spermatozoa versus 61.16%) and normal sperm morphology (19.75% versus 40.51%). The decline in sperm count was 30.31% where as sperm motility and morphology was reduced by 22.92% and 51.25% respectively between the time span of 13 years. Interestingly, the incidence of severe oligozoospermia (mean sperm count <10 million/ml) compared between 2002–2005 and 1993–1997 demonstrated a significant inverse relationship (P < 0.001). Conclusion: This study provides the first evidence that the quality of human semen evaluated for infertility is deteriorating in the southern part of India over years, which may be due to various environmental, nutritional, lifestyle or socio-economic causes. More importantly, the increase in the incidence of sperm morphological abnormalities in addition to low sperm count observed in this study indicates qualitative impairment of spermatogenesis and perhaps of the Sertoli cells. The significant time-related decline in semen quality observed in this study has important implications with respect to fertility. Further studies are warranted, using a large cohort of normal subjects with additional information on their occupation, socioeconomic status, lifestyle-related factors, in order to confirm the findings of the current report.
AC-012
AC-013
Declining semen quality among south Indian infertile men: a retrospective study Jayaraman V, Adiga SK, Kalthur G, Upadhya D, Kumar P Kasturba Medical College, India [email protected]
Correlation between basal FSH and oestradiol concentrations and embryo quality in IVF Guyansyah A, Djuwantono T, Permadi W, Majid TH, Anwar R POGI Indonesia, Indonesia [email protected]
Introduction: Male reproductive function has recently attracted increasing attention due to reports on regional difference and time-related decline in semen quality. Although, the baseline semen quality and sperm functional parameters in fertile Indian men have been documented, the first report investigating changes in semen characteristics in Indian men over the period of time demonstrated no significant decline in sperm count from 1990–2000. In view of high population density, heterogeneous nature of the Indian population, climatic differences and dietary habits, it is necessary to know whether similar trend exists within the different parts of the same country. The specific objective of this study was to investigate the semen quality in terms of the sperm concentration, total sperm motility, sperm morphology and incidence of azoospermia among large cohort of infertile individuals at a regional level over a period of 13 years.
Introduction: Basal hormonal examination is a standard procedure in IVF. Factors that keep IVF from being successful are decrease of quality and follicle reserve in the ovary, which can be predicted by measuring basal follicle stimulating hormone (FSH) and oestradiol concentration. The objective of this study was to determine the correlation between basal FSH, oestradiol concentration and quality of oocytes, clinical pregnancy after ovarian stimulation in IVF. Materials/Methods: This was a retrospective cohort study. Data of patients who undertook the IVF programme and met the inclusion and exclusion criteria were taken from medical records at Aster Fertility Clinic Assisted Reproductive Technology Unit, Department of Obstetric and Gynecology Medical Faculty, University of Padjadjaran/ Hasan Sadikin Hospital Bandung, Indonesia from May 2005 to July 2007. All patients underwent down-regulation using
S-22 Reproductive BioMedicine Online, Vol. 16, Suppl. 2, April 2008